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HomeMy WebLinkAboutMINUTES - 07082003 - C106 TO: BOARD OF SUPERVISORS �_ � Contra FROM: J'OH'N SWEETEN, County Administrator Costa o DATE: JUNE 30, 2003 - ounty SUBJECT: RESPONSE TO GRAND JURY REPORT NO. 0304, ENTITLED "AN AGE OLD PROBLEM" SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ADOPT report as the Board of Supervisors' response to Grand Jury Report No. 0304, entitled "An Age Gid Problem". BACKGROUND: The 2002/2003 Grand Jury filed the above-referenced report on April 15, 2003, which was reviewed by the Board of Supervisors and subsequently referred to the County Administrator, who prepared the attached response that clearly specifies: A. Whether the finding or recommendation is accepted or will be implemented; B. If a recommendation is accepted, a statement as to who will be responsible for implementation and a definite target date; C. A delineation of the constraints if a recommendation is accepted but cannot be implemented within a six-month period; and D. The reason for not accepting or adapting a finding or recommendation. CONTINUED ON ATTACHMENT: YES SIGNATURE: -- - --------------- ----------------------------------------------------------------- - �D�A�T�ION ---------------------------- -RECOMMENDATION OF COUNTY ADMINISTRATOR RECOIi�/1 OF BOARD COMMITTEE APPROVE OTHER j t SIGNATURE(S): ----------------------------------------------------- ACTION OF BOAR Y $, 20(03 APPROVE AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN X UNANIMOUS(ABSENT IV ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: DISTRICT III SM VACANT ATTESTED: JULY 8, 2003 CONTACT: JULIE ENEA(925)335-1077 JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CC. BOARD OF SUPERVISORS MEMBERS PRESIDING JUDGE OF THE GRAND JURY GRANDJURYPOREMAN COUNTY ADMINISTRATOR HEALTH SERVICES DIRECTOR EMPLOYMENT AND HUMAN SERVICES DIRECTOR COUNTY PROBATION OFFICER BY `° �� �r ,DEPUTY .............I...........................................I...... ........ ............................................... RESPONSE TO GRAND JURY REPORT NO. 0304 AN AGE OLD PROBLEM FINDINGS 1. Any elder can be a victim of abuse, since it occurs in all socioeconomic classes and across all racial/ethnic groups. Information received from Elder Abuse Prevention indicates that women over the age of 75, who have mental or physical impairments that cause them to depend on others for care, are at greatest risk of abuse. Without a care-giver, an elder can fall into the "self- neglecting" population. According to Adult Protective Services (APS)*this group constitutes 51% of referrals to its program in our county. *APS is a subsidiary of County Aging and Adult Services. It is the social service agency designated by law to intervene in cases of elderldependent adult abuse and neglect Response: Agree. 2. Neglect is the most common form of elder mistreatment. The care- giver/abuser is most often a family member who provides care to the older person. The reasons are multidimensional: Stress from responsibility of providing care, financial difficulties, inadequate support system, poor family relationships, and at times, exacerbated by the care giver's substance abuse. Response: Agree. 3. There is often great reluctance and/or fear on the part of the elder to report abuse. Threats of placement in a nursing home or shame that a family member may be involved often prevent the elder from seeking help. The number of abuse reports from nursing homes is low because residents often are unable to communicate to authorities, and they are also afraid of retaliation by staff. Therefore, one of the issues surrounding elder abuse is that it is very difficult to alleviate due to the lack of reporting. Response: Agree. Actual incidences of abuse may be under-reported. 4. Currently, there are three public agencies that deal with elder abuse, the Offices of the Public Administrator, Public Conservator, and Public Guardian. These agencies, which are part of County government, operate independently of each other and are not mutually supportive or efficient, and do not concentrate the resources and personnel in one area. Response: Partially disagree. The Aging and Adult Services Bureau of the Employment and Human Services Department (EHSD) is the public agency responsible for administering the Adult Protective Services (APS) Program under the Welfare and Institutions Code in Contra Costa County. APS provides social casework intervention to protect elders and dependent adults from abuse, neglect, and exploitation. Under the APS, EHSD also serves as the Temporary LPS (Lanterman Petris Short) Conservator, and investigates all referrals for LPS Conservatorship. If the Superior Court orders permanent conservatorship, the case is referred to the Health Services Department The Health Services Department, through its Mental Health Division, is the public agency responsible for administering guardianship and long-term LPS conservatorship programs. LPS conservatorship provides mental health treatment to individuals who are considered gravely disabled due to a mental disorder, and who are unable or unwilling to give consent for psychiatric treatment. Public guardianship protects conservatees through estate administration. Mile the District Attorney's Office has a small Elder Abuse Prosecution Unit, the Public Administrator function of the District Attorney handles estates of individuals who die with no known heirs. In its role as the Public Administrator, the District Attorney does not deal with elders or elder abuse, but only with the estates of deceased individuals. .............I........................................................................................................ ........................................................................................................................... -............................. An Age Old Problem June 30, 2003 County Response to Grand Jury Report No. 0304 Page 2 The Sheriff and city police departments have law enforcement responsibilities with regard to elder abuse. In the absence of specific examples of lack of support or inefficiency, the Board cannot adequately respond to the finding. Contra Costa County has successfully implemented many multidisciplinary teams, e.g. the Permit Bureau, the award- winning Service Integration Teams (SIT), and both financial and forensic multidisciplinary teams to protect elders. Although the organization of services to address elder abuse crosses multiple County departments, the programs are run efficiently and are supportive of each other to the extent practicable. In a June 16, 2003 report to the Board's Family and Human Services Committee, the EHSD Director states: "Moreover, APS works closely with co-located Health Services nursing and mental health staff who provide essential consultation and evaluation for APS clients and with Health Services programs including ConservatorshiplGuardianship, Mental Health, Public Health, Medical Social Services, CCHP(Health Plan), inpatient, and outpatient care. The Long Term Integration planning project jointly sponsored by EHSD and HSD is in the process of designing an action plan to redirect funding to expand the availability of home and community services for elders and adults with disabilities and to enhance collaboration between our two departments and community-based organizations who serve our clients." The Director also states: "Integration of health services personnel(a public health nurse and a mental health specialist) into APS activities represents the gold standard of practice in bring an interdisciplinary approach to casework. Cooperating with Health Services through interdepartmental service agreements has been invaluable.'; and "The District Attorney's elder abuse prosecution unit has been especially supportive to APS staff and its role will only increase in significance as APS gains more expertise in uncovering financial abuse." Clearly, the framework established by the Board of Supervisors to provide a continuum of services to protect elders and other adults is functional and meeting with success. 5. The In-Home Supportive (IHSS) Program, which is a subsidiary of Aging and Adult Services, pays the wages of care-givers to work in the clients' homes. These wages are paid by check ordered by the IHSS payroll staff and issued from the Office of the State Controller in Sacramento. Care-givers receive full benefits and may be relatives or friends. Relatives or friends are not required to undergo background checks, which would eliminate obvious undesirable candidates from acceptance into the program. Other care-givers are available through a registry maintained by the County Public Authority. However, as determined by this Grand Jury investigation, background registry checks are not always in depth due to time and resource constraints. Response: Agree, with the clarification that IHSS caregivers receive only partial benefits including health insurance, and retirement plan contributions of 15 cents per hour. Benefits do not include dental or vision care, vacation, sick leave or other accrued time off. An Age Old Problem June 30, 2003 County response to Grand Jury Report No. 0304 Page 3 6. In Contra Costa County, the social casework staff working in the APS program regularly takes action to protect at-risk elders and dependent adults without resorting to the complexities of protective custody. A major objective of the casework staff is to keep elders at home as long as possible without having them transferred to nursing establishments. Response: Agree. 7. Elder abuse is treated as a serious crime in this county. The County's study of "Zero Tolerance for Domestic Violence," compiled by the Contra Costa County Administrator's Office, as of June 2002, addresses violence, abuse and neglect of vulnerable elders by training and educating service providers, promoting elder abuse reporting, and bringing elder abusers to justice. The study demonstrates that the problem of elder abuse has been recognized and some steps have been taken to reduce the problem. Response: Agree. 8. Financial abuse is one of the most frequently reported forms of elder abuse. Therefore, the Office of the District Attorney is continuing to develop a Financial Abuse Specialist Team (FAST). The primary goal of the FAST is to decrease elder financial abuse by prevention and effective intervention through group consultations and educational forums for service providers, members of the financial community, and the public. Response: Agree. 9. If current Aging and Adult Services programs that address elder abuse are eliminated, or curtailed, the many dedicated professionals and volunteers who are struggling to obtain and maintain control will realize there is little to no hope in winning the war against elder abuse. The affected programs would likely include the Medi-Cal/Food Stamp program, Area Agency on Aging, Adult Protective Services, and In-Home Support Services. Response: Disagree. Notwithstanding recent budget and service reductions, the County continues to place a high priority on elder abuse remediation and has laid the foundation for a comprehensive system to respond to cases of elder abuse and other forms of domestic violence. In 2000, the Board of Supervisors adopted the Zero Tolerance for Domestic Violence (ZTDV)policy as evidence of its awareness of domestic violence, including elder abuse, and its commitment to fight it. The Board continues to dedicate $9.8 million annually for the ZTDV Program, which provides myriad specialized domestic violence services through several County departments. This annual allocation supplements the APS and other programs already in place to combat elder abuse. In addition to utilizing the County's limited resources to provide a comprehensive system to combat elder abuse, County departments have conducted training sessions and forums to increase public awareness of the problem and mobilize community-based organizations to help. Last year, ZTDV funds were used to provide training to community professionals on recognizing elder abuse, and on the available resources to effectively respond to and intervene in elder abuse situations. +C 3NGLU 5IONS 1. Elder abuse, in its various ramifications, is a major problem and concern. An Age Old Problem June 30, 2003 County Response to Grand Jury Report No. 0304 Page 4 2. Elder abuse is a problem that will get worse as our population ages. Fortunately, the problem is recognized for its significance and steps have been taken to educate our citizens to the seriousness of elder abuse, assist those in need, and prosecute offenders. Adult Protective Services, the Office of the District Attorney, Eider Abuse Prevention, and others, all provide educational programs on this subject. 3. Vigilance, awareness and willingness to report violations can drastically reduce all forms of elder abuse. Aggressive efforts to educate care-givers and the public, increase services and swiftly prosecute abusers are rapidly showing a return in the form of better protection for elders. 4. It is critical that additional steps be taken now to protect our current elderly population from abuse, and to assure that our aging population will not be subjected to abuser violence in the decades to follow. RECOMMENDATIONS The 2002.2003 Grand Jury makes the following recommendations to the Contra Costa County Board of Supervisors and to the Office of the District Attorney: 1. All Aging and Adult Services programs dedicated to the prevention, detection, reporting, and prosecution of elder abuse actions and their perpetrators not be eliminated or curtailed in the upcoming budget. Response: Will not be implemented. On June 24, 2003, the Board adopted the 2403104 Budget, which included a 25% staffing reduction, or four positions, in the APS Program because of the unavailability of County funds above and beyond the matching funds required by the State and Federal funding sources for APS activities. The Board agrees that these reductions are undesirable, yet unavoidable under current circumstances. The Board, however, sustained the $1.8 million allocation to the ZTDV initiative. 2. Within six months integrate the offices of the Public Administrator, Public Guardian and Public Conservator within the Office of the District Attorney. A central location will make it easier for the elderly to navigate through the maze of available services, and to promote efficiency within the County Government. Response.: Will not be implemented because it is not warranted and not preferred. The recommendation appears to be predicated on the premise that a multi-department, interdisciplinary effort cannot be efficient or effective. The County has demonstrated that such an effort can be both efficient and effective by bringing together specialized services to focus on a narrowly defined problem and population. Functionally, the continuum of programs to remedy elder abuse are organized (as described in the Board's response to Finding No. 4) to allow the County department that has the expertise to provide a specialized service to do so and to align, to the maximum extent possible, responsibility for providing services with accountability for providing them effectively and within funding constraints. While co-locating all staff that provides these services may be desirable, reorganizing the programs primarily around that goal detracts from the specialized nature of each program and would likely reduce the effectiveness of the programs. For example, the Public Administrator(under the District Attorney)administers the estates of deceased individuals. The Conservatorship/Guardianship functions do not fit closely with the prosecution An Age Old Problem June 30, 2003 County Response to Grand Jury Report No. 0304 Page 5 mission of the District Attorney. The overwhelming majority of the work done by the Public Guardian and Public Conservator is social service work not related to criminal elder abuse. Additionally, organizing short-term LPS conservatorship (intake) and long- termlpermanent conservatorship under the same department may unnecessarily create conflicts of interest in establishing conservatorship cases and obtaining statelfederal resources for services. Consequently, the conservatorship and guardianship functions are organized under the Health Services Department (Mental Health Division) in recognition of the close interrelationship among the services provided under each function, and the strong alignment of these functions with the capabilities and general mission of the HSD. Conservatorship intake is organized under EHSD, where many of the conservatorship cases are initiated. 3 ExpandCounty Public Guardian services to provide probate conservatorship services to non-institutionalized individuals when APS staff has determined these persons` estates are at risk of financial abuse or exploitation. Expansion of these services would permit prompt intervention to protect the financial assets of vulnerable adults and would enable the County to enhance the successful model of the Financial Abuse Specialized Team (FAST). Response: Will not be implemented because of insufficient resources. The County is understaffed in both probate conservatorship and LPS conservatorship functions. The County has attempted to maintain essential conservatorship and guardianship functions in the wake of shrinking state funding allocations. No additional County funding is currently available to expand these services. 4. In order to help prevent or delay the necessity of moving at-risk adults from their own homes to institutional care services, expand casework intervention and community based services for adults vulnerable by self-neglect to intervene early in their cycle of functional decline. The social casework staff working in the APS program must continue to take actionfintervention to protect vulnerable elders and dependent adults without resorting to the complexities of protective custody. Response: Will not be implemented because of insufficient resources. The County has attempted to maintain essential APS services in the wake of shrinking state funding allocations. No additional County funding is currently available to expand these services. 5. IHSS care-givers, whether family, friends or obtained from the County Registry, undergo a background check before acceptance into the IHSS Program. All care-givers paid by the Program must be "cleared" and recommended by IHSS staff in order to reduce incidents of elder abuse. Response: Will not be implemented because of insufficient resources and lack of control by County. Mandatary background checks and clearances for all IHSS providers would require resources beyond the County's current means and would entail meeting and conferring with the IHSS provider union representatives. Furthermore, although the County pays the caregivers'wages, the County does select the individual caregivers. The County maintains a registry of caregivers and makes a reasonable effort to ensure the quality of caregivers on the registry. The IHSS clients personally hire their own caregivers and the County has no say in the individual selection.